AIBU about "Birth after Caesarean" clinic.

[Caff2]

I had an elective section for my second child after previous traumatic birth. At booking in appointment for current pregnancy, I asked the community midwife about elective section this time, and she said she would refer me to consultant again, and did, to same consultant I had last time, and I got an appointment letter through to see said consultant in September.

Today, I had a letter from the "Birth after Caesarean" team giving me an appointment in August to "discuss options for women considering vaginal births aftersection or planned sections". I was confused as to what this clinic was, as I already have an appointment to see the consultant to discuss this. So I rang up to enquire. The hospital midwife I spoke to was quite cagey about what the appointment was for and said it was to "discuss it". So I said "Well, I already have an appointment to discuss the elective section I want with Mrs X (consultant) in September - won't she go through it all with me again?". At which the midwife said "Well, I'll cancel this appointment then, as it's clear to me that we won't be able to change your mind, so there's no point"!!

AIBU to be a bit upset about this and think that they should be more honest about what this clinic is for, as it is plainly to try and talk people out of having planned sections, and not to discuss "Options for women considering vaginal birth after section OR PLANNED SECTIONS"?

YANBU. It's dishonest and disrespectful of women. As several posters have said, reasons for needing a C-section are often due to distressing/traumatic circumstances. They should be up front about the purpose of the clinic so you can make an informed choice if you want to attend or not.

It undermines the relationship between women and the NHS if they are not truthful, imo.

I agree with the suggestion to complain - they could re-word the leaflet to be more transparent in future.

Micah - why did they not want to talk about any of those things with me when I said I wanted another elcs then? Why was their award for reducing the number of planned sections? It's a very easily googleable article as I said above.

Planned sections should be discouraged. It's extra strain on the nhs to perform an operation and a vaginal birth is better for the baby. Anyone who puts their own agenda before the health off their unborn child is selfish and unreasonable imo

TheSky At Night - thanks - I am going to raise it with my community midwife at appointment next week. I have NO OBJECTIONS to the clinic's existence, that's great. My objection is purely to do with the lack of transparency, which, for reasons you have said above, can cause distress to sometimes very vulnerable patients.

Even if they won an award for reducing the number of CS it doesn't necessarily mean that they are solely about trying to convince women to have a VBAC.

If you were very insistent that you were going to have a CS and said that you had an appointment with the consultant to discuss it next month then she probably didn't see any reason for you to come to the clinic.

youareallbonkers - unnecessary planned sections are not a good idea, no. My "agenda" is to avoid massive birth trauma (again) with its resultant years of harm. I hope you're not a midwife. You're not are you?

It's extra strain on the nhs to perform an operation NICE guidelines point out that ELCS may well be cheaper in the long run when downstream costs of vb are taken into account - incontinence for eg.

vaginal birth is better for the baby What about the mother? She is the one actually giving birth? Do you give a shit about what is better for her?

My obstetric consultant tells me a planned C-section is the safest delivery option for babies.

By the way, my birth trauma wasn't physical. Or no more than one would expect from a normal birth. The birth did leave me with PTSD though.

bumbleymummy - she SAID there was no point as they "wouldn't be able to change my mind". The purpose of the clinic IS to reduce ELCS - it does say that in the article.

I have no objection to the clinic, I really don't. I DO object to the dishonesty, as I keep saying.

Caff2 YANBU. At all. The lack of transparency is so patronising.
I googled the article. They want women to have a "normal" birth after CS.
And they've saved 61,000. Never mind the after care that can be needed after a traumatic vaginal delivery or the subsequent operations some women can need. And in this case women who MAY be statistically more at risk.
There is nothing wrong with a high ELCS rate, if there are healthy mothers and babies at the end of it.

Caff, well, yes, the clinic is obviously there to try to reduce the CS rate but it doesn't mean that it's solely about convincing women to have a VBAC. As others have already said, some women actually want to try to have a VBAC, may be worried about it or not even sure that it's possible and this is where they would get the information and reassurance that they need to make an informed decision.

Her wording was a bit off, I grant you, but if the clinic is there to discuss all possible options and you know you're going to have a CS then there isn't really much to discuss is there? She knew you had another appointment with the consultant who is going to give you all the CS info.

Micah: "The clinic is not to talk you into a vaginal birth."

It is, though - as the OP says. NHS trusts are under a lot of pressure to reduce the c-section rate, and one of the easiest (though not necessarily the best) ways of doing this is to encourage women to have a vbac. If a woman is reluctant, they will try and give counselling to discuss her fears etc.

Glad you stood your ground, OP.

YANBU

I think that women should be given factual information around pregnancy / birth / feeding related matters, and if there are recommendations due to medical history they should be given with reasons, and then the adult women should be allowed to make their own bloody minds up.

Too much around this is to do with persuading / coercing women into doing whatever it is the midwives / PCT / whoever think is "best". It's really really shit.

Yes this was a VBAC persuasion session and she's pissed off that you aren't going to be on the "persuadable" list.

Also WTF @ youareallbonkers. I had a planned section with DC2 due to placenta praevia. You say it would have been better for the baby to have been born vaginally. OK right Ditto insisting the OP should be forced to relive an extremely traumatic experience when she doesn't need to. OK well that's nice Someone here is bonkers for sure.

I also think that anyone who puts "well it's cheap" at the top of the list rather than "it's best for the patient" is, well, questionable. And I'm not sure how cheap it will be for the NHS to have to handle all these critically injured / dead women and babies when the planned sections are all cancelled.

But it wasn't advertised as a "elective c-section advice clinic" either and you have a consultant to discuss that with anyway.

What you said, WhirlpoolGalaxy .

"If a woman is reluctant, they will try and give counselling to discuss her fears etc." Which there is nothing wrong with and clinics like this could provide such support and let people have the natural birth they've been wanting.

Well, I'm glad that not everyone thinks I'm being unreasonable. This clinic is falsely represented, and I think it is really underhand to try to pretend it's something it's not.

Why NOT tell people upfront that it's purpose is to encourage VBAC? It took ages for it to become obvious on the phone too, and the only place it's made explicit is in the article which I googled after the phone call.

I, obviously naively, took the letter at face value at first hence the call to clarify what it would be about and whether it was necessary as well as the consultant appointment to discuss options REGARDING ELCS.

Crumbly biscuits, the letter DOES say to discuss options regarding ELCS as well as VBAC. It DOES. But that is not what they want to do at all.,

What I really don't understand (I know I'm repeating myself but no one seems to really have an answer for this) is why the bloody hell they do not say that this is a clinic to encourage VBAC? As this is what it actually IS.

I'm sorry you've had this experience. I'm trying to remember what the clinic I was invited to after my emergency c-section was called - it may even have been the "VBAC clinic". In any case, despite it being a perfectly amicable conversation, I felt there was an agenda to push VBAC, and I felt that my consultant who luckily I saw the following week was much more open-minded. Actually I think she said planned section as we wished was the best option, which indeed it was as when I had my planned section, my uterine scar was worryingly thin.
I also found that the discussion in the VBAC clinic brought back upsetting thoughts of my first birth, which wasn't ideal! Sounds like you've come across someone with an agenda, but you are lucky to have a sensible and understanding consultant - stick with the plan from that discussion. Congratulations on your pregnancy!

YANBU. I think it's shameful that NHS money is being spent trying to bully women out of what should be their choice.

Fully 1 in 5 of the women who went through that clinic and were persuaded into trying vb had all the pain of an attempted vb then had to have an emergency c-section anyway.

How much less difficult would it be for them to have just got what they wanted in the first place?

I think it's good the NHS tries to get more VBACs, they're usually very successful and don't cos the NHS thousands like C-Sections do.

I'm preg ATM and got a leaflet about birth options and it said for second time mothers we would like you to consider a VBAC as it's very safe etc and had a similar thing going.
Women used to have to beg for a VBAC a few years ago, I think it's great they have a choice now

Fugghetaboutit - can you tell me why the clinic's not open about what it is then? Like Lilipot15's was? Can you help with that?

Ok, so I have also been asked if I'd like to attend this group - I had emcs last time and am likely to opt for elcs next time, but am interested in discussing options, as far as I'm concerned knowledge is power, no one is going to brainwash me (!) and my midwife (who I trust) has assured me that there is no bias/push in this group towards vbac. OP, I think you are overreacting.

youarealllbonkers I'm trying not to rise to your bait, but well. What you say is an insult to women's freedom of choice. What is right for mum and best for the baby are interlinked incredibly closely. The majority of doctors choose to have ELCS. Why should women not assess the pros and cons and decide for themselves?

Are you anti-abortion too? I wonder if you'd have the guts to talk to someone who's experienced a serious or permanent birth injury about how terrible Elcs are.